Relação entre o índice de resistência vascular e o sucesso hemodinâmico de revascularizações distais dos membros inferiores / Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization

Resumo Contexto A cirurgia de revascularização é proposta para restaurar o fluxo sanguíneo para o pé nos casos de isquemia crítica (IC) devido a doença arterial obstrutiva periférica dos membros inferiores (MMII). O uso de ultrassonografia com Doppler (USD) vem despontando nos últimos anos como um método de grande valor para o planejamento cirúrgico dessa intervenção. Objetivos Avaliar a relação entre o índice de resistência (IR), mensurado por meio de USD, e o sucesso hemodinâmico imediato da cirurgia de revascularização dos MMII em pacientes com IC. Métodos O tipo de estudo empregado foi a coorte prospectiva, na qual foram avaliados 46 pacientes portadores de IC dos MMII submetidos à operação de revascularização infrainguinal por angioplastia ou em ponte de agosto de 2019 a fevereiro de 2022. Todos os pacientes foram submetidos à avaliação clínica vascular, à USD com medida do IR das artérias distais dos MMII, à arteriografia dos MMII e à aferição do índice tornozelo-braquial (ITB) no período pré-operatório. No pós-operatório imediato, todos os pacientes foram submetidos à nova aferição do ITB. Resultados Entre os 46 pacientes avaliados, 25 (54,3%) eram do sexo masculino. A idade variou de 32 a 89 anos (média de 67,83). Quanto ao sucesso hemodinâmico, avaliado pela comparação do ITB pré e pós-operatório, constatou-se que 31 (67,4%) pacientes apresentaram sucesso hemodinâmico após cirurgia de revascularização (aumento do ITB em 0,15 ou mais). Foi observada correlação positiva (p ≤ 0,05) entre o IR da artéria distal revascularizada do MMII e o sucesso hemodinâmico imediato avaliado pela aferição do ITB (IR menor e sucesso hemodinâmico). Conclusões Na presente pesquisa foi observada uma correlação positiva entre o índice de resistência arterial distal e o sucesso hemodinâmico nas revascularizações dos membros inferiores, avaliada através do índice tornozelobraquial, de forma que, quanto menor foi o IR, maior o sucesso hemodinâmico obtido.

Abstract Background Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention. Objectives To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI. Methods The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period. Results Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success). Conclusions This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.

Malformación arteriovenosa uterina. Un reto diagnóstico y terapéutico / Uterine arteriovenous malformation: A diagnostic and therapeutic challenge

Introducción: Las malformaciones arteriovenosas uterinas (MAVU) generalmente se presentan como sangrado vaginal en mujeres en edad fértil. Los antecedentes obstétricos o quirúrgicos uterinos y la ecografía son clave para la sospecha de esta dolencia. Existen múltiples tratamientos disponibles tanto médicos como quirúrgicos, con efectividad diversa. Material y métodos: Analizamos el proceso diagnóstico y terapéutico de 3 pacientes con episodios de metrorragias y antecedentes obstétricos o cirugías uterinas que presentaban MAVU. Resultados: En los 3 casos analizados, se realizó tratamiento médico como primera elección. Tras el fracaso del tratamiento médico mediante gestágenos orales, metilergometrina o ácido tranexámico, se realizó embolización transarterial con oclusión del nido o punto de la fístula. Conclusiones: Con base en nuestra experiencia, debido a la demora entre el diagnóstico y la amplia variedad de tratamientos de las MAVU, la embolización supraselectiva podría valorarse como uno de los tratamientos con mayor tasa de eficacia en un perfil de paciente que habitualmente no ha completado su deseo genésico. Aunque los resultados a corto plazo parece que no afectan a la fertilidad, sería importante realizar un seguimiento prospectivo de estas pacientes en lo que respecta a la consecución de nueva gestación o recidiva de MAVU.(AU)

Introduction: Uterine arteriovenous malformations (UAVM) usually present as vaginal bleeding in women of childbearing age. Obstetric or uterine surgical history and ultrasound are key when suspecting this pathology. There are multiple treatments available, including medical surgery or interventional radiology with different effectiveness. Material and methods: We analysed the diagnosis and management of three patients with episodes of vaginal bleeding and obstetric history, or uterine surgeries with a MAVU diagnosis. Results: In the three cases analysed, medical treatment was provided as first line treatment. After the failure of medical treatment with oral gestagens, methylergometrine, or tranexamic acid, transarterial embolization was performed with occlusion of the nidus or fistula point. Conclusions: Based on our experience, due to the delay between diagnosis and the wide variety of MAVU treatments, supraselective embolization could be assessed as one of the treatments with the highest rate of efficacy in a patient profile that has usually not fulfilled their reproductive desire. Although the short-term results do not seem to affect fertility, it is important to prospectively follow-up these patients regarding achievement of a new pregnancy or recurrence of MAVU.(AU)

Síndrome de Kounis, un infarto olvidado: reporte de caso / Kounis syndrome, a forgotten infarction: case report

La anafilaxia es una causa poco frecuente de síndrome coronario agudo por vasoespasmo con o sin la presencia de enfermedad coronaria subyacente. Presentamos el caso de un síndrome de Kounis en un paciente masculino sin factores de riesgo conocidos para enfermedad coronaria quien presentó un síndrome coronario agudo con elevación de ST que requirió manejo con adrenalina, soporte vital básico e ingreso a Unidad de Cuidados Intensivos; con arteriografía coronaria sin evidencia de enfermedad subyacente.

Anaphylaxis is a rare cause of vasospasm acute coronary syndrome with or without the presence of underlying coronary disease. We present the case of Kounis syndrome in a male patient with no known risk factors for coronary heart disease who presented with acute coronary syndrome with elevation of ST that required management with epinephrine, basic life support, and admission to the Intensive Care Unit; with coronary arteriography without evidence of underlying disease.

Uso de modelos de predicción de eventos cardiovasculares para pronóstico de lesión vascular coronaria significativa / Use of cardiovascular events prediction models for the prognosis of a severe coronary artery lesion

Resumen Objetivos: Determinar el mejor punto de corte y el grado de conformidad de las escalas de riesgo, Framingham, PROCAM y Reynolds, para el diagnóstico de lesión vascular coronaria arterioesclerótica severa a través de la comparación de las áreas bajo la curva de acuerdo con las curvas operativas del receptor (COR). Métodos: Estudio de corte transversal en adultos que fueron sometidos a arteriografía coronaria. Se aplicaron las escalas Framingham, PROCAM y Reynolds, las dos primeras ajustadas según estudio de calibración colombiano. Luego se realizó la recolección de los datos de manera concurrente en instituciones de referencia en cardiología y hemodinámica en Bogotá. Resultados: De 200 pacientes estudiados, 66% eran mujeres, 37,5% mayores de 70 años, 53,2% con hipertensión, 52,7% en sobrepeso u obesidad, 61,5% presentaron valores altos de Proteína C Reactiva ultrasensible (PCRus) y 50% tenían al menos una lesión coronaria mayor de 70%. Se encontraron los mejores puntos de corte, de acuerdo con cada curva de características operativas del receptor (COR): Framingham ajustado 5,8% (sensibilidad 80%, especificidad 41%). PROCAM ajustado 1,7% (sensibilidad 78%, especificidad 45%) y Reynolds 3,8% (sensibilidad 68%, especificidad 45%). Adicionalmente, se encontró que las tres escalas presentaron áreas bajo la curva (ABC) de 0,59, 0,59 y 0,57, respectivamente.

Abstract Objectives: To determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. Methods: A cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjusted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. Results: Of the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.

Conservative management in iatrogenic splenic trauma after chest tube insertion.

Insertar un tubo torácico es una maniobra terapéutica de gran valor, pero no exenta de complicaciones. Nuestro objetivo es poner de manifiesto una nueva opción de tratamiento mediante técnicas radiológicas intervencionistas que eviten los riesgos de una cirugía en pacientes seleccionados. Presentamos el caso de un paciente pluripatológico con diagnóstico de empiema pulmonar izquierdo al que de manera accidental se le insertó un tubo torácico en el polo superior esplénico. La comorbilidad del paciente y la presencia de estabilidad hemodinámica abogaron por un tratamiento conservador mediante cateterización esplénica supraselectiva e introducción de cola quirúrgica en la retirada del tubo.

Inserting a chest tube is a therapeutic tool of great value not without complications. Our objective is to highlight a new treatment option using interventional radiological techniques that avoid the risks of surgery in selected patients. We present the case of a multi-pathological patient with a diagnosis of left pulmonary empyema who accidentally inserted a chest tube into the splenic superior pole. The comorbidities of the patient and the presence of hemodynamic stability advocated conservative treatment through supraselective splenic catheterization and the introduction of surgical glue in the withdrawal of the tube.

Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases / Tratamento endovascular de pseudoaneurisma decorrente de pancreatite crônica: relato de dois casos

Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.

Resumo O pseudoaneurisma decorrente de pancreatite crônica consiste em complicação rara, porém com alta taxa de mortalidade. Está etiologicamente associado à pancreatite crônica, e seu diagnóstico é feito mais comumente após ruptura, manifestando-se através de sinais clínicos de hemorragia aguda. A tomografia computadorizada desempenha papel importante no diagnóstico; contudo, a angiografia por subtração digital mantém-se como método padrão-ouro para confirmação diagnóstica e direcionamento do tratamento. O presente artigo relata dois casos de pseudoaneurisma em pacientes com pancreatite crônica alcoólica, sendo um da artéria esplênica e outro da artéria gastroduodenal, complicados com sangramento torácico e abdominal respectivamente. Ambos foram submetidos a tratamento endovascular minimamente invasivo com sucesso, através de implante de molas e de stent-grafts.

Does gastric conditioning decrease the incidence of cervical oesophagogastric anastomotic leakage? / ¿Puede el acondicionamiento gástrico disminuir la incidencia de dehiscencia anastomótica esofagogástrica cervical?

INTRODUCTION: Oesophageal reconstruction by gastroplasty with cervical anastomosis has a higher incidence of dehiscence. The aim of the study is to analyse the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning of the gastric conduit. METHODS: Prospective analysis of patients who underwent gastric conditioning two weeks prior to oesophageal reconstruction, from January 2001 to January 2014. The conditioning was performed by angiographic embolization of the left and right gastric artery, and splenic artery. The main variable analysed was the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis. Secondary variables analysed were the result of the conditioning, complications arising from that procedure and in the postoperative period, and mean length of postconditioning and postoperative hospital stay. RESULTS: Gastric conditioning was indicated in 97 patients, with neoplasia being the most frequent aetiology motivating the oesophageal reconstruction (76%). 96 procedures were successfully carried out, arterial embolization was complete in 80 (83%). The morbidity rate was 13%, with no mortality. Postoperative morbidity was 45%; the most frequent complications associated with the surgery were respiratory problems. Six (7%) patients experienced cervical fistula, and all received conservative treatment. The rate of postoperative mortality was 7%. CONCLUSIONS: In our serie the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning is 7%. Angiographic ischaemic conditioning is a procedure with acceptable morbidity.

Spinal arteriovenous fistulas in adults: Management of a series of patients treated at a neurology department. / Fístulas arteriovenosas espinales del adulto. Manejo de una serie de casos desde una planta de Neurología.

OBJECTIVE: Spinal arteriovenous fístulas (SAVF), a rare type of vascular malformation, account for 3% of all spinal cord lesions. Without early treatment, the associated morbidity is high; furthermore, SAVF pose a major diagnostic challenge. Our purpose was to evaluate the clinical characteristics of SAVF and review their progress after treatment to determine whether it may be too late for treatment in some cases. METHODS: We present a retrospective series of 10 patients diagnosed with SAVF and treated at a tertiary hospital during a 3-year period. RESULTS: In our sample, SAVF were found to be significantly more frequent in men (80%). Mean age in our sample was 65.4 years. The most common initial symptom was intermittent claudication/paraparesis (70%). In most patients, symptoms appeared slowly and progressively. At the time of diagnosis, the most common symptoms were motor, sensory, and sphincter disorders. Mean time from symptom onset to diagnosis was 24.3 months. Initial diagnosis was erroneous in 60% of the patients. Spinal MRI was diagnostic in 90% of these cases and arteriography in 100%. The most common location of the fistula was the lower thoracic region and the most frequent type was dural (7 cases). All patients were treated with embolisation, surgery, or both and 70% improved after fistula closure regardless of progression time. CONCLUSIONS: Diagnosis of SAVF is difficult and often delayed, which leads to poorer patient prognosis. We should have a high level of suspicion for SAVF in patients with intermittent claudication or paraparesis exacerbated by exercise. Early treatment should be started in these patients. Treatment should always aim to improve quality of life or stabilise symptoms, regardless of progression time.

Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication. / Pseudoaneurisma de arteria segmentaria lumbar tras introducción de tornillo transpedicular L5. Una rara complicación vascular.

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation.

Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate. / Diagnóstico y embolización con cianoacrilato de pseudoaneurismas de origen ginecológico.

Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate.

Glaucoma secundário a fístula carótido-cavernosa / Secondary glaucoma following carotid cavernous fistula

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.

Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection.

INTRODUCTION: Cervical artery dissection (CAD) is the cause of 2% to 3% of ischaemic strokes and 10% to 25% of the ischaemic strokes in young people. Our objective is to evaluate whether implementation of a comprehensive stroke centre (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD. PATIENTS AND METHODS: Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our centre: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods. RESULTS: Nine patients were diagnosed with CAD in pre-CSC and 26 in post-CSC, representing 0.8% and 2.1% of all ischaemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24 hours in 42.3% of the patients in post-CSC versus 0% in pre-CSC, by using urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. Both severity of stroke (median NIHSS score 11 vs. 3, P=.014) and time to neurological care (265 min vs 148, P=.056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, and all treatments were post-CSC. The functional outcome was comparable for both periods. CONCLUSIONS: Implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke.

Hemoptisis por enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria en un paciente joven / Hemoptysis due to Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia in a young patient

Se presenta el caso clínico de un joven de 20 años de edad, con el diagnóstico de hemoptisis moderada, quien fue ingresado en la Unidad de Cuidados Intensivos del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, donde se le realizaron múltiples exámenes, cuyos resultados permitieron llegar al diagnóstico definitivo de enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria. Luego de la aplicación de otros procederes, el paciente evolucionó satisfactoriamente y egresó de la institución(AU)

The case report of a 20 years young patient is presented, with the diagnosis of moderate hemoptysis who was admitted in the Intensive Care Unit from Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, where multiple tests were carried out whose results allowed to arrive to the definitive diagnosis of Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia. After the indication of other procedures, the patient had a satisfactory clinical course and he was discharged from the institution(AU)

Hemoptisis por enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria en un paciente joven / Hemoptysis due to Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia in a young patient

Se presenta el caso clínico de un joven de 20 años de edad, con el diagnóstico de hemoptisis moderada, quien fue ingresado en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, donde se le realizaron múltiples exámenes, cuyos resultados permitieron llegar al diagnóstico definitivo de enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria. Luego de la aplicación de otros procederes, el paciente evolucionó satisfactoriamente y egresó de la institución.

The case report of a 20 years young patient is presented, with the diagnosis of moderate hemoptysis who was admitted in the Intensive Care Unit from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, where multiple tests were carried out whose results allowed to arrive to the definitive diagnosis of Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia. After the indication of other procedures, the patient had a satisfactory clinical course and he was discharged from the institution.

Bullet embolism of pulmonary artery: a case report / Embolia pulmonar por projétil de arma de fogo: relato de caso

The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure.

Relatamos o caso de um paciente vítima de tiros por arma de fogo e com uma rara complicação: embolia venosa de um projétil desde a veia ilíaca externa esquerda até o ramo lingular da artéria pulmonar esquerda. Radiografias de corpo inteiro ou tomografia computadorizada do corpo inteiro devem ser utilizadas. Angiografia digital fica reservada para complementação diagnóstica ou como procedimento terapêutico.

[Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV]. / Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV.

OBJECTIVE: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. MATERIAL AND METHODS: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The "head bone removal" tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received. RESULTS: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). CONCLUSION: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.

[Selective embolization to treat obstetric hemorrhage]. / Embolización selectiva como tratamiento de la hemorragia obstétrica.

OBJECTIVE: To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. MATERIAL AND METHODS: We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. RESULTS: Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. CONCLUSION: Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.

Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position.

OBJECTIVE: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. MATERIAL AND METHODS: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. RESULTS: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. CONCLUSIONS: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit.

Evaluación clínico imagenológica de la isquemia crónica de miembros inferiores en pacientes atendidos en el Hospital Lucía Íñiguez Landín / Clinical Ultrasonographic Assessment in Chronic Lower Limbs Ischemia Patients. Lucía Íñiguez Landín Hospital

Se realizó, de agosto 2003 a agosto 2007, un estudio descriptivo de serie de casos, retrospectivo y prospectivo en pacientes con consentimiento informado procedentes de la Consulta de Angiología del Hospital Clínico Quirúrgico Lucía Iñiguez Landín para diagnosticar la isquemia crónica de miembros inferiores mediante angiografía por sustracción digital. Existió un predominio del grupo de edad de 70 a 79 años con una incidencia superior en el sexo masculino, encontrándose el mayor número de pacientes dentro del grupo II. La región vascular femoropopitlea fue el más afectado con un predominio de las estenosis de las arterias, como hallazgo más significativo en el estudio angiográfico y existió una correspondencia entre los hallazgos clínicos y los angiográficos. La angiografía por sustracción digital constituyó un método valioso en el estudio de la isquemia crónica de los miembros inferiores...(AU)

A descriptive, retrospective and prospective study in patients from the Angiology Consulting Room at Lucia Íñiguez Landín Teaching Clinical Hospital to diagnose chronic lower limbs ischemia by digital subtraction angiography was carried out from August 2003 to August 2007. The age group between 70 and 79 years, male sex prevailed. Most of the patients were included in group (II).The vascular femoral- popliteal region was the most affected one with a prevalence of stenosis of the arteries as the most significant finding. There was a correspondence between clinical and angiographic findings, which demonstrated the effectiveness of the digital subtraction angiography method for chronic ischemia of lower limbs study...(AU)

Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects / Dissecção espontânea da artéria cervical: atualização sobre aspectos clínicos e diagnósticos

Spontaneous cervical arterial dissection (SCAD) is a non-traumatic tear or disruption in the wall of the internal carotid arteries or the vertebral arteries. It accounts for about 25 percent of strokes in patients aged under 45 years. Awareness of its clinical features and advances in imaging over the last two decades have contributed to earlier identification of this condition. SCAD has become the commonest form of vascular lesion identified in the cervical carotid and vertebral arteries, second only to atherosclerosis. This review is an update on the epidemiology, vulnerable arterial segments, risk factors, clinical features, diagnosis, current treatment and prognosis of SCAD.

Dissecção arterial cervical espontânea (DACE) é uma laceração ou ruptura na parede de artérias cervicais responsáveis pela irrigação sanguínea cerebral: artérias carótidas internas e artérias vertebrais. É responsável por cerca de 25 por cento dos acidentes vasculares cerebrais isquêmicos em pacientes abaixo de 45 anos de idade. Ao longo das duas últimas décadas, com a maior conscientização sobre suas manifestações clínicas e o avanço das técnicas de neuroimagem, a DACE tem sido diagnosticada mais precocemente, tornando-se o tipo de lesão vascular mais comumente identificado nas artérias cervicais, sendo superada apenas pelas lesões ateroscleróticas. Esta revisão é uma atualização sobre a epidemiologia, segmentos arteriais mais vulneráveis, fatores de risco, manifestações clínicas, diagnóstico, tratamento e prognóstico da DACE.